Transplantation of organs: a comment on Paul Ramsey.

In his admirably thorough and deservedly influential book The Patient as Person, Paul Ramsey deals at length with the problem of transplantation of organs from living donors. He refers to his study as "this deliberately inconclusive inquiry." This itself is interesting; for it is one of the few times Ramsey has wrestled with a contemporary problem and the inquiry has emerged "inconclusive." Ramsey's concern is above all with the way transplantation from living donors is to be justified. The basic problem is that "for the first time in the history of medicine a procedure is being adopted in which a perfectly healthy person is injured permanently in order to improve the well-being of another " For many decades the ethics of mutilation was formulated within the perspectives of the principle of totality. That principle stated that individual limbs, organs, functions—relating to man's bodily life and health as parts to the whole—could be excised or suppressed if the excision or suppression was necessary or proportionately useful for the whole good of the organism. Increasingly moral theologians began to speak of the "whole good of the person" as best encapsulating the intentions, permissions, and limits of that principle. But whatever the formulation in the discussions of twenty years ago, there was general agreement with Gerald Kelly's contention that "no mutilation for the good of the neighbor, even a minor mutilation, can be justified by the principle of totality." Such statements were not meant to exclude transplantation from living donors; they were but assertions that the principle of totality could not justify them. Recently, however, not a few theologians have seen in the principle of totality the very justification of organ donation. Obviously, if that is the case, the principle most be broadened to include the spiritual and moral wholeness of the person—a wholeness that resides in and can be pursued and achieved by charitable donation to others. Thus, Warren Reich speaks of the "subordination of the physical perfection (of the donor) to his own perfection of grace and charity This would expand the notion of the total person (psychological and spiritual, as well as physical) beyond that which was originally envisioned in the 'principle of totality"' Similar amplifications have been proposed by others.